Healthcare Provider Details

I. General information

NPI: 1205253804
Provider Name (Legal Business Name): COMFORTABLE HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SHINGLE CREEK PKWY STE 365
BROOKLYN CENTER MN
55430-2155
US

IV. Provider business mailing address

6200 SHINGLE CREEK PKWY STE 365
BROOKLYN CENTER MN
55430-2155
US

V. Phone/Fax

Practice location:
  • Phone: 763-951-3382
  • Fax: 763-951-3420
Mailing address:
  • Phone: 763-951-3382
  • Fax: 763-951-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATONYA HOLIFIELD
Title or Position: PRESIDENT/DIRECTOR
Credential:
Phone: 763-951-3382